| NPI | 1982685996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A23373) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A23373) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: CA A23373) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2007-07-08 |